Code of Maine Rules
90 - INDEPENDENT AGENCIES
590 - MAINE HEALTH DATA ORGANIZATION
Chapter 241 - UNIFORM REPORTING SYSTEM FOR HOSPITAL INPATIENT DATA SETS AND HOSPITAL OUTPATIENT DATA SETS
Section 590-241-2 - Hospital Inpatient and Outpatient Service Data Sets Filing Description
Universal Citation: 90 ME Code Rules ยง 590-241-2
Current through 2024-38, September 18, 2024
Each hospital shall file with the MHDO or its designee a completed hospital inpatient data set and a completed hospital outpatient data set for every service provided to each patient. A completed hospital data set includes professional and facility services as defined in the appendices.
A. General Requirements
(1)
Codes
(a)
Code Sources. The code
sources listed and described in Appendix A are to be utilized with the
inpatient and outpatient data file submissions.
(b)
Specific and Unique Coding.
Except for location of service codes and provider number, specific or unique
coding systems shall not be permitted as part of the inpatient and outpatient
data submissions.
(c)
External Cause Codes. External Cause Codes shall be assigned for
all initial treatments of an injury, poisoning, or adverse effect of drugs. If
a patient is transferred to another facility for continued treatment, this
facility shall also assign the appropriate External Cause Code.
(2)
Definitions for Required
Data Elements. Unless otherwise specified, the definitions for the
required data elements described in Appendix B-1 and Appendix C-1 are the same
as those provided in the most current National Uniform Billing Data Element
Specifications as developed by the National Uniform Billing Committee and
approved by the State of Maine Uniform Billing Committee.
(3)
Inpatient Data Filing. Data
for all inpatient services of the hospital must be submitted based on the
discharge date and filed under the MHDO provider code assigned to that
hospital.
(4)
Outpatient Data
Filing. Data for all outpatient services of the hospital and all
services provided by specialty groups or primary care practices must be filed
in one or more outpatient data streams under the MHDO provider code assigned to
that hospital. Every encounter that is populated with a designated subset of
Place of Service codes must include a Location of Service code, internally
created by the Hospital. Also, each hospital shall submit annually an updated
Location of Service crosswalk, which includes unique location of service code,
full location name, address, city, state, and zip code for those locations
only.
(5)
Adjustment
Charges. Adjustment charges and negative values are not to be reported
in inpatient and outpatient data sets. The adjustment charges are reconciled to
the individual line item for which the adjustment applies.
B. Detailed File Specifications
(1)
Filled Fields. All fields
shall be filled where applicable. Non-applicable text fields shall be space
filled. Non-applicable numeric fields shall be zero filled and shall not
include decimal points.
(2)
Position. All text fields are to be left justified. All numeric
fields are to be right justified.
(3)
Individual Elements and
Mapping. Individual data elements, data types, field lengths, and
mapping locators (UB-04, CMS 1500, ANSI X12N 837) for each file type are
presented in the following appendices:
(a)
(i) Inpatient Data Specifications - Appendix
B-1
(ii) Inpatient Data Mapping to
National Standards Formats - Appendix B-2
(b)
(i)
Outpatient Data Specifications - Appendix C-1
(ii) Outpatient Data Mapping to National
Standards Formats - Appendix C-2
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